The Potential Prognostic Significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) Score in Necrotizing Fasciitis

Abstract

Context: Discutăm despre rolul indicatorului de risc de laborator pentru fasceita necrozantă (LRINEC) asupra prognosticului acestei boli. Fasceita necrozantă (NF) se caracterizează prin răspândirea rapidă a infecţiei şi a necrozei ţesutului moale şi a fasciei. Metode: Treizeci de pacienţi (17 bărbaţi, 13 femei, vârsta medie 57,5 ani) au fost trataţi în perioada 2011-2016; au fost analizaţi retrospectiv în ceea ce priveşte vârsta, sexul, agenţii microbiologici izolaţi, modalităţile de tratament şi rata mortalităţii. Rezultate: Majoritatea infecţiilor au fost detectate în perineu (14, 46,7%), alte localizări ale infecţiei fiind regiunea presacrală (3, 10%), regiunea abdominală după intervenţie chirurgicală de elecţie (10,33,3%) şi intervenţie chirurgicală de urgenţă (2, 6.7%). 53,3% dintre pacienţi au prezentat cel puţin un factor comorbid predispozant, cum ar fi diabetul zaharat, hipertensiunea, cardiomiopatia şi insuficienţa cardiacă congestivă. Culturile de ţesut au fost pozitive la 12 (40%) pacienţi. Scorul mediu LRINEC la internare a fost de 8,5 ± 2,85. A existat o corelaţie puternică între scorul LRINEC şi vârsta pacientului (p = 0,018, R = 0,43). Scorul LRINEC nu a fost afectat nici de sex, nici de prezenţa oricăror comorbidităţi. Pacienţii au fost clasificaţi conform sistemului de stadializare Wang şi Wong: 1 pacient în stadiul 1 (3,3%), 15 în stadiul 2 (50%) şi 14 în stadiul 3 (46,7%); pacienţii cu stadii Wang şi Wong mai mari aveau scoruri LRINEC semnificativ mai ridicate. Rata mortalităţii este de 16,7%.

Can scoring systems determine the length of hospital stay in cases of Fournier's gangrene?

“…In one study, the mean cut-off value of the FGSI scores was determined to be 7.5 in mortality cases (10). In another study, the LRINEC score was found to be 9.2 in patients with a mortal course of FG, and 8.4 in patients who survived (20). The disease severity score in our study was mostly found to be lower than the data of advanced medical centers (9,10,12).…”

“…They found that as the LRINEC score increased, the length of hospital stay increased. However, they determined the cut-off value as 6 and did not find a significant difference in the duration of hospitalization between groups (14 days vs. 21 days, p=0.21) (20). One study found that non-mortal FG patients with an FGSI score of 5.7 and a LRINEC score of 7.4 may have an extended hospital stay of 52 days (21).…”

“…Some studies have suggested that FGSI and LRINEC could be used as predictors of length of hospital stay. The cut-off value and length of stay in these studies were heterogeneous and contradictory (6,20). In their study, Gönüllü et al used the LRINEC scoring system in necrotizing fasciitis patients, half of whom also had FG.…”

Necrotizing Soft Tissue Infection: A Single-Center Retrospective Study of Treatment and Outcomes

“…In addition to them, significant comorbidities that affect the worsening of the prognosis are chronic renal failure, chronic heart disease, alcoholism, immunosuppression, systemic disorders, cirrhosis, local trauma, intravenous drug abuse, malnutrition, peripheral arterial disease [ 19 - 20 ]. In a study by Gonullu et al, more than half of the patients had at least one predisposing comorbidity and the most common (50%) comorbidity factor was diabetes mellitus [ 21 ]. Tarchouli et al reported an incidence of diabetes mellitus in 38% and cardiovascular diseases (high blood pressure, heart disease) in 51%, with a significantly higher mortality rate in heart disease [ 22 ].…”

“…Tarchouli et al reported an incidence of diabetes mellitus in 38% and cardiovascular diseases (high blood pressure, heart disease) in 51%, with a significantly higher mortality rate in heart disease [ 22 ]. The effects of diabetes mellitus on mortality rate in NF is less clear, and several studies could not detect the correlation between mortality and DM [ 21 ]. In our study, DM occurs in 69%, obesity in 61%, high blood pressure in over 80%, heart disease in 46%, and chronic kidney disease (CKD) and malignancy in 15%.…”